创伤性结直肠损伤的处理

MANAGEMENT OF TRAUMATIC COLORECTAL INJURIES

目的：探讨创伤性结直肠损伤的诊断和处理方法，提高早期确诊率和治疗成功率。方法：回顾性分析我院1992～2003年收治的32例结直肠损伤病例的临床资料。结果：早期确诊24例（75％），误诊8例（25％）。32例结、直肠损伤均经手术治疗，其中单纯缝合修补24例，一期结肠切除吻合5例，共29例，一期手术率90．6％，无肠瘘发生。二期肠造口或外置3例，占9．4％。死亡一例（3％），切口感染2例。结论：结直肠损伤以钝性闭合伤为主，一期手术应为首选；二期手术仅适用于结肠重度损伤、腹腔重度污染；而损伤早期容易误诊，应引起重视。

Objective：To study the diagnosis and current management strategy for colorectal injuries, improve the efficiency of early diagnosis and treatment. Methods： The clinical data of 32 cases of colorectal injury from 1992 to 2003 were retrospectively analysed. Results： Of 32 cases, 24（75% ） were diagnosed early and 8 （25%） were misdiagnosed. Operations were performed in all patients. In addition, of 24 cases, simple one stage repair of colorectal injury and the one stage anastomosis after excision of injuried colon were performed making up 90.6% of the first stage operation rate, while the proximal colostomy plus repair or excision of traumatic colorectalm was done in 3 cases making up 9.4% of the colostomy rate with 1 cases died, infection occurred in 2 cases at anastomosis. Conclusion：Most colorectal traumas are blunt closed type in clinic. Primary repair or resection and anasto： moesis at the initial exploration is most often used for colorectal injuries. Indications for diverting colostomy are severe shock, heavy intra -abdominal contamination, and rectal injury, and that emphasis should be put on the early stage diagnosis of the ingury, because of the misdiagnosis is early made.